THE 46TH VOLUME of the Socialist Register, Morbid Symptoms, brings
together an eclectic set of papers to investigate health care and
capitalism from a "systematically critical standpoint." (ix)
In 17 wide-ranging chapters, such disparate topics as medical TV dramas,
pharmaceutical industry practices, obesity and the food industry, and
maternal mortality in Africa are explored. "Our goal in preparing
this volume," write the editors, Leo Panitch and Colin Leys,
"was to help develop the historical materialist analysis of health
under capitalism." (ix) They note, moreover, that it is imperative
to address the "marketisation of public health services, and the
way the pharmaceutical, insurance, medical technology and healthcare
corporations push to make health care everywhere into a field of capital
accumulation and expand the consumption of medical commodities."
(x) The book is an informative piece of work and generally successful in
addressing major medical debates.

Morbid Symptoms focuses explicitly on "the economic, social,
and political determinants of health" in an era of neoliberalism and globalization. (ix) It is an important topic, one justifying further
discussion, and the editors duly offer a brief overview of their field.
They argue that despite significant and pioneering research by Lesley
Doyal, Julian Tudor Hart, and Vicente Navarro in the 1970s, scholars
have subsequently failed to build on this line of inquiry. Therefore,
Morbid Symptoms acts as a corrective and aims to galvanize not only
debate in the field but also amongst members of "the Left."
According to Panitch and Leys, it is necessary to shift attention away
from the affluent North (especially the United States), where the
relationship between capitalism and health produces perverse outcomes,
and they also point toward developing countries and economies as
constructive categories of analysis. Africa, Cuba, China, Europe and
India receive scrutiny and 'Americanization' emerges as a
predominant theme.

The opening article, written by Colin Leys, establishes many of the
book's governing principles and charts the steady growth of, as the
title of this collection suggests, health under capitalism. In an
ambitious analysis that connects the recent financial crisis of
2007-2008 with over a hundred of years of history, Leys seeks to explode
one core myth: that capitalism promotes health. The myth had its
genesis, he suggests, in England's mortality revolution in the late
19th century. As sanitation, nutrition, and medical knowledge improved
so too did life expectancy and physical stature. Thereafter, Leys
provides the basic structural frameworks and narratives for many of the
subsequent articles; in sections called "After the Mortality
Revolution," "Public Health," "Health Care Since the
Therapeutic Revolution," "Health Care and Legitimation:
Ideology," and The Re-Commodification of Health Care," Leys
chronicles the inexorable rise of capitalism in health care
policy-making.

A significant highlight of the book is its emphasis on Africa, as
well as such countries as China, India, and Cuba. According to Paula
Tibandebage and Maureen Mackintosh, maternal mortality in Sub-Saharan
Africa requires further evaluation in the future but also offers a
lens--a "gender lens"--to understand the gendered structure of
health systems and health policy. Shaouang Wang presents an arresting
view of the "double movement" in Chinese health care. In
Wang's estimation, during Mao's era the health of the
population was one of the country's proudest boasts; with economic
reform in the late 1970s, however, a widening gap between regions,
between urban and rural populations, and between rich and poor
households, invariably harmed the nation's health. This in turn
produced a backlash - a protective counter-movement--that has seen the
government allocate more money for health care. Similarly, in a
well-researched and compelling overview of health care and policy-making
in India, Mohan Rao offers an incisive perspective on the struggle
between the public and private models of health care in the context of
neoliberal globalization. Rao's gloomy conclusion holds that at
least since the earl), 1990s the gulf between the two health systems has
widened. Consequently, health inequalities have increased. Finally,
Julie Feinsilver offers an illuminating and comprehensive account of
Cuba's medical system. Touching on the evolution of Cuba's
health ideology and medical diplomacy, the article provides a
well-sourced and refreshing evaluation of

the strengths and weaknesses of Cuban health care.

Morbid Symptoms is not a work strictly of history, but rather a
text that adopts an interdisciplinary approach. Indeed, anthropologists,
economists, political scientists, physicians, and sociologists ail
contribute articles; resultantly, the selection of papers is both
wide-ranging and haphazard. Problematically, the editors deign not to
organize the papers along such thematic lines as geography or to
segregate the papers that were heavily weighted with theory. Sometimes
this approach works; sometimes it does not. Also, likely to the
consternation of historians of medicine, a majority of the articles
possess little, if any, original primary or archival research.
Nevertheless, scholars of all stripes can surely benefit from this book:
the text bridges disparate and innovative subject matters to further
expand and enhance the subject of health care policy and economics.

LUCAS RICHERT University of Saskatchewan

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